When we elect officers, neither they nor the electorate know what opportunities and emergencies lie ahead. In The American, the president has the responsibility and authority to engage in administration, all the while gaining an ongoing education from many sides. The organization and the president continually move into unexplored territory and unforeseen positions. Leadership requires that the president provide direction, accept the majority will, and negotiate with minority voices so that a larger vision, one nurtured through dialogue, is translated into organizational imperatives. The chemistry of communication is critical. During my four years in office I have explored many ways to improve communication and have, I think, enhanced that chemistry.
I have changed in the more than four years since my election. For that I am extremely grateful, but neither you nor I could have anticipated those changes. In my plenary address next December, I plan to focus on our psychoanalytic understanding of the agents and mechanisms of change in late adulthood. For now, I'd like to review some of our recent history, in order to provide a context for the organizational positions that have evolved.
I hope you will share my pleasure in what has been accomplished, as well as the optimism I feel about our future as an organization.
My first responsibilities as president-elect focused on the Central Office. There a major transition was in the making. Helen Fischer, who had provided organizational continuity for more than thirty-five years, was terminally ill and about to retire (in December of last year, within the week of the meetings, she died; see the memorial notice and eulogy on page 34). In negotiating her retirement arrangements, Steve Firestein and I were plunged into the arcane world of actuaries, tax lawyers, and accountants specializing in pension plans. In the process it became clear that our other employees needed a properly funded retirement program (ERISA) so that the costly and time-consuming efforts we were making would never have to be repeated. Since then, a pension plan has been established. After hours of interviewing and discussion, a replacement was found for Helen, and the process helped define our organization and its internal problems as never before. Over the next two years, personnel policies were formulated with the help of a labor lawyer, conditions in the Central Office were brought into conformity with the fire code, the expenses of officers and committee chairs were catalogued and publicized, and a lawyer was hired to organize our ethics files for the transition from one Ethics Committee chair to the next.
The computerization of the office became a reality, as our computers were linked and reprogrammed. An accounting program was chosen by Paul Mosher and the Executive Committee, aided by a consultant, and this program and others were put into place and staff trained in their use. Thus, an organization whose history had resided in someone's head made a shaky but definite transition to becoming an organization of rules and files. Other essential housekeeping details will be dealt with by Ellen Fertig, who last August assumed her responsibilities as our new and galvanizing administrative director. Policies have been instituted covering confidentiality and destruction of documents (procedures necessary for all organizations, including societies and institutes), and a fax-on-demand system and World Wide Web pages have been initiated (much of this through the hands-on work of Paul Mosher); they must now be integrated into our administration. Oversight of these activities is still in process; Mel Mandel has assumed responsibility for keeping the Web site current, and Elise Snyder has taken responsibility for the timely production of TAP, freeing Bill Jeffrey to concentrate on creativity and content.
External events were carrying us along at the very moment we were getting our house in order. The health plan crisis brought us closer to the Psychoanalytic Consortium; we knew we needed allies and numbers when we appeared in Washington to speak to the Mental Health Task Force. Marvin Margolis spearheaded that effort, which provided us an opportunity to work closely with the American Academy of Psychoanalysis, the Division of Psychoanalysis (39) of the American Psychological Association, and the National Membership Committee on Psychoanalysis in Clinical Social Work. At the same time, Allan Rosenblatt coordinated our cooperative efforts with both the Consortium organizations and the four American IPA institutes, heading off the NAAP/ABAP attempt to gain CORPA recognition as U.S. accrediting body for psychoanalysis. Aspects of both endeavors were successful. Since that time we have continued to monitor and mount initiatives against NAAP's state-by-state efforts to obtain legislative recognition. The Consortium's widespread membership and contacts have been extremely helpful in enabling us to respond to legislative threats through a variety of organizations. We are considering developing model legislation, to be introduced state by state, so that we are not always fighting rearguard actions.
Despite these gains, our increasingly intimate involvement with the Consortium, the IPA institutes, and the health care initiatives brought to the fore a number of thomy issues that had to be dealt with by the Executive Council and the Board on Professional Standards. In late 1994, two major issues, the Consortium and lobbying—both centered on external relations, customarily the purview of the Executive Council—roiled our internal waters. At the December meeting that year, debate over joining the Consortium took place separately in both Board and Council. The Board, after prolonged debate, passed a resolution at the end of the day that recommended that the Council accept a restrictive motion passed by the Board. Reassured by our lawyer that the Consortium's proposed bylaws protected our standards and limited the Consortium's ability to make commitments or issue statements without our agreement, the Executive Council did not accept the recommendation by BOPS. Instead the Council voted, without restrictions, to join the Consortium. At the subsequent Meeting of Members, a proxy vote sustained the Council decision.
Our organizational lobbying effort involved both a choice of lawyer by the Executive Committee, in conjunction with the Committee on Government Relations and Insurance, and the decision of Council to raise money to defeat aspects of what came to be called the Clinton Plan. The history of that first effort, directed from within The American, need not be retold. We were careful to protect our nonprofit status by receiving only personal checks, and by segregating and carefully monitoring our funds. CGRI strove mightily to contain and represent the many voices within the organization and to work with other groups where interests coincided. The emotional heat at the next Meeting of Members — held in Philadelphia in May, just before I took office — was intense. It is not our habit, it seems, to gird our loins, put aside personal differences, and plunge collaboratively into such efforts. Rancor continued over the next year. However, we are also fairly quick learners, and our organizational efforts, along with those of the Coalition for Patients' Rights, contributed to the defeat suffered by the
Clinton Plan when it was brought into the light of day.
It has taken almost two years of work since Philadelphia to bring the two lobbying groups together under one Washington representative. The joint efforts of Robert Pyles, our presidentelect, and Marvin Margolis, our incoming president, have clearly borne fruit. Marina Weiss of the Powers, Pyles law firm has been chosen as The American's legislative representative. At present, Art Farley and Sam Rubin, cochairs of a joint coordinating committee of CGRI and CPR, share responsibility for guiding our health care initiatives. They will work with Weiss and are also responsible for energizing local groups, not only of our members but of other professionals and consumers.
A third aspect of our external relations, as well as an essential aspect of our own integrity and belief in our work, is ethics. In December 1993 and again a year later, the Executive Council, acting in executive session, grappled, to its dismay, with major ethical issues. Our ethics procedures, under which a Joint Committee on Ethics had functioned for years, were in need of thorough revision. Fortunately, Ralph Engle, who has many years of experience in this area, both in the Massachusetts Psychiatric Society and in his local analytic society, agreed to form a subcommittee to revise the procedures. This group was funded to spend a weekend brainstorming and has come up with a document, which all societies will soon see in draft.
Serendipitously, alert members recognized the possible advantages of a fourth involvement with the world of public policy. When the Supreme Court agreed to review Jaffee v. Redmond, a case involving patient-therapist privilege and issues of confidentiality, we turned to the Consortium to share the work and the financial burden. The amici brief that resulted, worked on tirelessly by Paul Mosher (in his role as chair of the Joint Committee on Confidentiality) and by other dedicated members, including Jerry Beigler, is an inspiring document, one that can serve as a reference for all of us.
The payoff for all the work of computerization occurred when Steve Firestein, before retiring as treasurer last August, presented the Council, for the first time in its history, a comprehensive statement both of our expenses for the previous year and projected total outlay for the current year. A Budget and Finance Committee was empaneled then (see my column in TAP 30/1) and continues its work of understanding and further specifying our expenses and revenues. So far it has led a relatively conflict-free existence, but I suspect that as we learn more about our finances in the years to come, and as difficult choices must be made, the discussion of priorities will sharpen.
The Consortium and our lobbying initiatives clearly created some internal fallout, despite the apparent success of these efforts. The governance of The American had previously come under scrutiny in two reports originating during the administrations of George Allison and Bernard Pacella. Anton Kris, as chair of a blue-ribbon Bylaws Committee, first proposed that a third arm of the organization be established to secure the place of research in The American. Kris's committee, in the hope of alleviating tensions between Council and Board, also proposed a separate board of directors that would stand above those two bodies and the new research arm. Bob Pyles approached the question of restructuring from his post as chair of the Task Force on Board-Council Structure and Function. He had been most concerned that the Executive Council, The American's legally constituted board of directors, was too large and met too infrequently to be responsible for the actions of the organization. Both the Kris and the Pyles proposals were discussed and debated in Board and Council, despite time limitations occasioned by other pressing matters. In December 1995 the proposals were presented jointly, as a set of bylaws amendments, but were never brought to a vote in either Board or Council.
The Consortium continued as a source of division between BOPS and the Executive Council. Legislative lobbying on health care issues led to dissension within both the membership and the the Executive Committee. In May 1995 The American's lobbyist resigned, stating that irreconcilable conflicts within the Executive Committee and CGRI created a diffusion of directives that made his job impossible. The Executive Council, upon hearing this, and finding that certain documents could for legal reasons not be distributed to the entire Council for discussion, took the initiative. The Council later proposed its own ad hoc investigatory committee, chaired by Henry Kaminer, to review the documents leading to the rupture. That committee's assiduous work led to a report that was accepted by the Executive Council in December 1995 and published in TAP (29/4). Clearly, the Council had found one way to function as a more informed board of directors. At that same meeting, when the CGRI/CPR detente was announced, the Council nominated one of its members, Betsy Reid, to serve as a liaison to the small group guiding that effort.
Review of the lobbying issues led the Executive Council to a recognition that many of the operational relationships that had grown up over the years would benefit from formalization and compilation as a manual. The Pyles task force had suggested developing such a document, comparable to the Board on Professional Standards manual dating from 1984, when BOPS chair Homer Curtis had asked the Board to formulate its procedures for the benefit of new Fellows and to serve as a reference for other components of The American. The Executive Council, with a larger membership than the Board, and with far-reaching legal responsibilities as the board of directors of The American, has a pressing need for an equivalent document. Jon Meyer agreed to head a Select Ad Hoc Committee on Council Structure and Function that would produce, as part of its review of the Council's fiduciary responsibilities and functions, a draft manual for discussion at the May meeting. (Meyer briefly described the work of his committee in TAP 30/1.)
Criticism that councilors are given insufficient time to discuss the budget, examine new documents and initiatives, and explore contentious issues is appropriate. It can be met either by holding more frequent Council meetings or by assembling the Council electronically, in a forum that delegates and alternates can access in a timely manner. The expense of an additional annual meeting, even a curtailed one, hovers around $15,000. An Executive Council “list” can be ongoing, provide for discussion by councilors of previously circulated documents, and enable the councilors to involve their societies in an enlarged debate. On March 1 we reached a critical mass of councilors, committee chairs, and Executive Committee members engaged with this electronic meeting space. The incoming administration may find additional ways to assist our newly energized and active Council.
The opportunities to move ahead are countless. I do not believe private practice is moribund. We receive more applications for the APsaA Fellowships than ever before; our Web site is a magnet for worldwide participation; and the media have shifted their focus as the faults and problems of managed care become more evident. Even the postponement of the Library of Congress Freud exhibit has had its upside: articles have since appeared that inform the public of controversies about Freud scholarship in the context of academic freedom and congressional censorship. Our communications consultant's report should be ready for the May meeting and will serve as a guide for creating a coherent plan for the next five years.
I know that innovative plans will proliferate under our next president. He will strengthen our bases in academic, clinical psychology, and social work programs, and reach out to resident and medical student populations crossing racial and ethnic lines. I hope we will also find ways to help analysts relocate to centers where they can create both viable analytic practices and support for our discipline. Chicago's innovative program of teleconference teaching, supported by the American Psychoanalytic Foundation under Harvey Rich, may make wider geographical dispersion more attractive to analysts. Marvin Margolis, I believe, is likely to find himself facing challenges he hadn't anticipated, but I am confident that he too will be able to cope and innovate in meeting those new demands. He will be supported by a hardworking and experienced Executive Committee that will help him find the best avenues of advance for The American. There is much to do, and I leave the president's office renewed in my belief that we can do it.